Provider Demographics
NPI:1083173652
Name:PRIME CARE HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:PRIME CARE HEALTH SOLUTIONS
Other - Org Name:PRIME CARE HEALTH SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:E
Authorized Official - Last Name:AGUWA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:817-897-7460
Mailing Address - Street 1:13601 PRESTON RD STE 520
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4911
Mailing Address - Country:US
Mailing Address - Phone:214-613-2019
Mailing Address - Fax:
Practice Address - Street 1:2100 N HWY 360 STE 1906A
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1040
Practice Address - Country:US
Practice Address - Phone:214-613-2019
Practice Address - Fax:214-617-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX399977301Medicaid